Healthcare Provider Details

I. General information

NPI: 1336009695
Provider Name (Legal Business Name): ALISA R PARSEGYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7579 SUNNYDALE LN
JACKSONVILLE FL
32256-1960
US

IV. Provider business mailing address

7579 SUNNYDALE LN
JACKSONVILLE FL
32256-1960
US

V. Phone/Fax

Practice location:
  • Phone: 904-338-1771
  • Fax:
Mailing address:
  • Phone: 904-338-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: